Presence Of Side Effects Research Articles

Adherence to drug treatment among schizophrenic patients in Jigawa State, Nigeria

Schizophrenia is among the most common psychiatric disorders, affecting approximately 1% of the world’s population and is among the leading cause of disability. Adherence to drug therapy is associated with favourable clinical outcomes and good quality of life among schizophrenic patients undergoing treatment. This study assessed the prevalence and factors responsible for adherence/ non-adherence to drug treatment among schizophrenic patients in Jigawa State. We used a descriptive hospital-based cross-sectional study design and recruited three hundred and ninety- nine patients using multi-stage sampling technique. The mean and standard deviation of age of the respondents was 42.3±11.2. The level of drug adherence was 47.1%. On bivariate analysis, cost of treatment, types of treatment, side effects, and effects of treatment on the performance were found to be associated with low adherence of drugs treatment (P<0.05). On adjusting for confounding effect using logistic regression analysis, the cost of treatment of more than one thousand naira per day (AOR=3.00, 95%CI=2.75-8.83) and presence of side effects (AOR=4.01, 95%CI=1.45-16.09) were found to be predictors of non-adherence to drug treatments. Supervised community treatment, behavioural change communications along with community mental health care financing were recommended in order to increase access and decrease non-adherence to drugs.

Capturing pharmacists\u2019 impact in general practice: an e-Delphi study to attempt to reach consensus amongst experts about what activities to record

BackgroundIn the UK, there is ongoing integration of pharmacists into general practice as a new healthcare service in primary care. Evaluation of the service involves national measures that require pharmacists to record their work, on the general practice clinical computer systems, using electronic activity codes. No national agreement, however, has been established on what activities to record. The purpose of this study was to attempt to reach consensus on what activities general practice-based pharmacists should record.MethodsThe e-Delphi method was chosen as it is an excellent technique for achieving consensus. The study began with an initial stage in which screening of a general practice clinical computer system and discussion groups with pharmacists from two ‘pharmacists in general practice’ sites identified 81 codes potentially relevant to general practice-based pharmacists’ work. Twenty-nine experts (pharmacists and pharmacy technicians from the two sites along with experts recruited through national committees) were then invited by e-mail to participate as a panel in three e-Delphi questionnaire rounds. In each round, panellists were asked to grade or rank codes and justify their choices. In every round, panellists were provided with anonymised feedback from the previous round which included their individual choices along with their co-panellists’ views. Final consensus (in Round 3) was defined as at least 80% agreement. Commentaries on the codes from all e-Delphi rounds were pooled together and analysed thematically.ResultsTwenty-one individual panellists took part in the study (there were 12 responses in Round 1, 18 in Round 2 and 16 in Round 3). Commentaries on the codes included three themes: challenges and facilitators; level of detail; and activities related to funding. Consensus was achieved for ten codes, eight of which related to activities (general and disease specific medication reviews, monitoring of high-risk drugs and medicines reconciliation) and two to patient outcomes (presence of side effects and satisfactory understanding of medication).ConclusionsA formal consensus method revealed general practice-based pharmacists’ preferences for activity coding. Findings will inform policy so that any future shaping of activity coding for general practice-based pharmacists takes account of pharmacists’ actual needs and preferences.

Depression and Anxiety as Key Factors Associated With Quality of Life Among Lung Cancer Patients in Hai Phong, Vietnam.

Background: Cancer is a leading cause of death. People living with cancer experience a variety of symptoms that might profoundly affect their quality of life (QoL). Objective: The study aims to identify factors associated with the QoL of patients with lung cancer at the oncology department of Viet Tiep Hospital, Hai Phong city, Vietnam in 2018. Methods: A cross-sectional study was conducted to collect data from lung cancer inpatients in Hai Phong city, Vietnam. The EQ-5D-5L and the EuroQol (EQ)-visual analogue scale (EQ VAS) were used to assess health-related quality of life (QoL). A multivariable regression analysis was performed on the EQ-5D utility score and the EQ VAS score as dependent variables, and socioeconomic, social support, and psychological factors as potential predictors. Results: A total of 125 lung cancer patients were enrolled in this study. The highest proportion of respondents reporting any problems was in anxiety/depression (92.8%), pain/discomfort (81.2%), usual activities (75.2%), and mobility (60%) dimensions, while the lowest percentage was in self-care dimension (40.8%). The multivariate analyses showed that a low QoL score was significantly associated with depression, incapacity to pay, low response to treatment, and presence of side effects. Conclusion: QoL of lung cancer patients is associated with anxiety/depression and other factors that can be modified by specific interventions. It is therefore possible to take care of psychological aspects to improve the QoL of Vietnamese people suffering from this condition.

Gluteal Augmentation with Polymethyl Methacrylate: A 10-year Cohort Study.

Many techniques for buttocks augmentation have been developed and published, for a more natural, satisfactory, and safe result for the patient. It has been a challenge to find a technique that presented not only volume gain but also gluteal remodeling. A total of 1,681 patients who underwent gluteal augmentation with Polymethyl methacrylate (PMMA) between 2009 and 2018 were selected for this retrospective cohort study. Data collected included demographics, procedures data, and postoperative outcomes. Side effects were calculated and compared using the Student's t test. A total of 1,681 patients (1,583 women and 98 men) who underwent 2,770 gluteal fillings had their cases retrospectively analyzed. They were injected with 540,751.00 mL of PMMA injected. The patients' mean age was 39 years, and the mean volume injected in each section was 237 mL during the first procedure and 147 mL during the second procedure. The authors observed 52 cases presenting side effects, representing a rate of 1.88% of 2,770 procedures carried out. The statistically significant (P = 0.02) presence of side effects was detected in relation to the total filling volume. This study has demonstrated that gluteal augmentation with PMMA is one of the best options for this type of procedure. In addition, the findings suggest that the guidelines concerning gluteal augmentation must include PMMA filler as an option because PMMA proved to cause few side effects, as demonstrated by this patient cohort.

The Effects of Infiltration of Liposomal Bupivacaine for Pain Control After Cesarean Delivery: A Randomized Trial [19T

INTRODUCTION: In response to the growing opioid epidemic, we determine whether the addition of liposomal bupivacaine infiltration administered above and below the fascial layer and within the subcutaneous tissue at the time of closure post cesarean delivery would reduce pain scores compared to the use of intra-thecal morphine alone. METHODS: Randomized, placebo-controlled, single-blinded study. Eligible women over 17 years of age and at least 34 weeks gestation, non-emergent cesarean delivery under spinal anesthesia. Random assignment to receive either intrathecal Astramorph® and saline wound infiltration or intrathecal Astramorph® and wound infiltration with liposomal bupivacaine (Exparel®). Primary outcome was post-operative pain scores measured via visual analog scale until discharge. Secondary outcomes included side effects and patient satisfaction. A t-test was used to assess differences between groups for continuous variables, and a chi-square test was used to assess differences for categorical variables. Informed consent and IRB approval obtained. RESULTS: Of the 22 eligible subjects identified during the study interval, 18 were randomized and completed the study. The groups were similar in regards to demographic parameters. As compared to the placebo group, the mean daily pain scores were significantly lower in the Exparel® group on post-operative days 1 and 2 (P < 0.05) and required less opioids. No significant differences between groups in satisfaction scores or the presence of side effects. No patients required additional opioid analgesia after discharge. CONCLUSION: Wound infiltration with liposomal bupivacaine during cesarean delivery reduced post-operative pain scores without increasing side effects. Supports the effectiveness of this multimodal approach to post cesarean delivery analgesia.

Anti-obesity Activity Tin Leaf Extract (Ficus carica Linn) on the Rats given High Fat Diets

Obesity is a health problem in the community because it can cause a risk of degenerative diseases such as type 2 diabetes mellitus, high blood pressure, heart disease, cancer, and atherosclerosis. Unhealthy lifestyles such as lack of physical activity by exercising, a diet high in carbohydrates and fats, can cause fat deposits in the body, especially in the abdomen. The use of chemical drugs such as Orlistat as a weight loss or to help reduce the risk of regaining lost weight, is less effective because it requires a long consumption time and the presence of side effects. Tin leaf content (Ficus carica Linn) is flavonoids, alkaloids, tannins and steroids, tin leaf extract has IC50 150mg/L antioxidant activity. This study was to determine the anti-obesity activity of tin leaf extract in male Sprague-Dawley rats given a high fat diet. 30 Sprague-Dawley rats were classified into 6 groups. The results obtained, in the group dose of 100 mg / kg obtained an average body weight of 381.8 grams, the test group 200 mg / kg obtained an average body weight of 414.5 grams, in the test group 400 mg / kg obtained 387 grams. The conclusion of this study is that the activity of Tin leaf extract (Ficus carica Linn) can be used as an anti-obesity.

The effectiveness of treatment of patients with stable coronary heart disease and concomitant arterial hypertension: the results of a multicenter study PRESTOL

The aim – to evaluate the profile of patients with coronary heart disease (CHD) and concomitant arterial hypertension (AH) who were administered bisoprolol as part of previous therapy, but did not reach normal levels of heart rate and blood pressure; to estimate the percentage of getting to recommended levels of heart rate, blood pressure and treatment adherence in patients after 4 weeks of using the fixed-dose combination of bisoprolol/perindopril with a correction of doses.Materials and methods. The study involved 170 cardiologists from various regions of Ukraine. Each researcher selected 15 consecutive outpatients with coronary heart disease who came for a regular visit. Inclusion criteria: age over 18 years old, blood pressure above 140/90 mm Hg, heart rate above 60 bpm, bisoprolol as part of antihypertensive therapy in the last ≥ 3 months. The study included two visits. At each visit, the patient’s objective status was assessed; an individual questionnaire with office systolic and diastolic blood pressure, heart rate, ECG data, clinical manifestations of CHD, risk factors, lifestyle features, concomitant diseases, current therapy was filled out. Medication adherence was also evaluated, the therapy was corrected if necessary and the presence of side effects and adverse events was registered.Results and discussion. 2785 patient questionnaires were provided by doctors, 2394 (86 %) of them met the inclusion criteria. The mean age of the patients was 61.4 years, men – 57.1 %, women – 42.9 %. The diagnosis of coronary artery disease was based on: chest pain – 751 (31.7 %), a history of documented myocardial infarction – 1281 (53.5 %), coronary ventriculography (VHR) – 735 (30.7 %), revascularization (CABG/stenting) – 474 (19.8 %) patients. The use of a fixed combination of previously taken drugs (perindopril, bisoprolol) for 4 weeks allows to reduce heart rate and blood pressure effectively (heart rate ≤ 70 bpm reached 84.9 % of patients, blood pressure ≤ 140/90 mm Hg – 86.9 %), to reduce the number of angina attacks from 4.4 to 2.6 per week and the need for nitroglycerin from 4.8 to 2.7 tablets per week, to improve therapy adherence in 66.5 % of patients.Conclusions. The study demonstrated that the use of the fixed combination of bisoprolol and perindopril in patients with coronary artery disease and concomitant hypertension, including those who had myocardial revascularization and myocardial infarction in anamnesis, helps to improve treatment efficacy, to achieve recommended levels of blood pressure and heart rate, to increase adherence to therapy.

Selecting Optimal Subgroups for Treatment Using Many Covariates

We consider the problem of selecting the optimal subgroup to treat when data on covariates are available from a randomized trial or observational study. We distinguish between four different settings including: (1) treatment selection when resources are constrained; (2) treatment selection when resources are not constrained; (3) treatment selection in the presence of side effects and costs; and (4) treatment selection to maximize effect heterogeneity. We show that, in each of these cases, the optimal treatment selection rule involves treating those for whom the predicted mean difference in outcomes comparing those with versus without treatment, conditional on covariates, exceeds a certain threshold. The threshold varies across these four scenarios, but the form of the optimal treatment selection rule does not. The results suggest a move away from the traditional subgroup analysis for personalized medicine. New randomized trial designs are proposed so as to implement and make use of optimal treatment selection rules in healthcare practice.

Abusive head trauma, healthcare, and childhood professionals’ lack of knowledge is detrimental to the child's interest

ObjectiveTo assess the knowledge of professionals on abusive head trauma (AHT) and shaking so as to adapt their training and thus promote the improvement of AHT screening and prevention. MethodA questionnaire was developed on the knowledge of the intensity of movement, the frequency of repetition, the existence and progression of sequelae over time, the legal nature of AHT as a criminal offence leading to the possibility of compensation, and the existence of HAS (French National Authority for Health) recommendations on shaken baby diagnosis and legal consequences. ResultsOver a 4-year period 311 physicians, 123 magistrates, and 644 early childhood professionals responded to the questionnaire as an introduction to a course on AHT. Whatever the professional field, incorrect answers (wrong or “I don’t know”) were frequent as to the possibility that play could induce AHT lesions (51–58%), the violence of the act (43–52%), the repetition of shaking (58–82.5%), the presence of side effects (52–58%), and the existence of recommendations to professionals (48–58.5%). Twenty to 47% of physicians and early childhood professionals were unaware that shaking a baby was a criminal offence and 20–27% were unaware that AHT required a report to the judicial authorities. Discussion/ConclusionThis lack of knowledge about AHT is detrimental to the child. The improvement of initial and continuing education is necessary to help reduce the dysfunctions existing in the care of child victims of AHT.

The Patient Perspectives on Future Therapeutic Options in NASH and Patient Needs.

Background: Non-alcoholic steatohepatitis (NASH) is a chronic liver disease with severe complications and without approved therapies. Currently, there is limited data on the overall burden of the disease for patients or on patient needs and preferences. This study investigates patient preferences in relation to potential future therapies for NASH. In addition, the factors that are relevant to patients and their importance in relation to future treatment options are explored.Method: Telephone in-depth interviews (TDIs) preceded an online 30-min quantitative survey. The online survey included (1) multiple choice questions (MCQs) on NASH diagnosis and disease background. (2) An exercise to determine patients' satisfaction levels with information provided at diagnosis, and to explore symptomatology in detail. (3) Exercises to evaluate potential new products and product attributes, including a “drag and drop” ranking exercise, and an adaptive choice-based conjoint exercise (ACBC). (4) The EQ-5D-5L questionnaire and the Visual Analog Scale (VAS), which measures patients' health status. (5) Collection of socio-demographic data, and (6) Questions to measure patient satisfaction with the survey.Results: There were 166 patients included in this study from Canada [n = 36], Germany [n = 50], the UK [n = 30], and USA [n = 50]. Fifty seven percent of patients [n = 94] had had a liver biopsy for confirmation of NASH. Patients were often unable to link their symptoms to NASH or other conditions. ACBC results showed that efficacy, defined as “impact on liver status” was the single most important attribute of a potential future NASH therapy. Other attributes considered to have secondary importance included impact on weight, symptom control and the presence of side effects. The EQ-5D utility score was 0.81 and VAS = 67.2.Conclusion: “Impact on liver status” is the primary outcome sought. Patients demonstrate a general lack of understanding of their disease and appeared to be unfamiliar with longer-term consequences of NASH. It is necessary to improve patient understanding of NASH and its progressive nature, and there is a need for improving confirmatory diagnosis and monitoring.

The association between side effects and adherence to antidepressants among primary care community-dwelling older adults

Aims: To evaluate the association between adherence to antidepressants and self-reported side effects while considering their tolerability among primary care community-dwelling older adults.Methods: This is a secondary analysis of data available for 137 individuals participating in the third wave of the Étude sur la Santé des Aînés – Services study (2015–2017) conducted among older adults aged 65 years and older. Adherence to antidepressants was assessed with the 4-item Medication Assessment Questionnaire. Side effects were also self-reported from a list of 20 potential side effects related to antidepressant use, while considering their tolerability (tolerable and non-tolerable) and were then grouped into seven categories specific to organ or function systems. Multilevel logistic regression analyses were carried out to assess the association between adherence and the presence of side effects accounting for participants nested within primary health clinics.Results: In this study, 69.3% of participants were adherent to their antidepressants and 30.7% were non-adherent. Participants reporting sleep disturbance (OR = 0.58, 95% CI = 0.47–0.72), gastrointestinal system (OR = 0.64, 95% CI = 0.45–0.92), and nervous system (OR = 0.60, 95% CI = 0.48–0.78) related side effects were less likely to be adherent to their antidepressants. Participants reporting palpitations were more likely to adhere to antidepressants (OR = 2.20, 95% CI = 1.03–4.67). With regards to severity, participants reporting non-tolerable nervous system related side effects were less likely to be adherent (OR = 0.37, 95% CI = 0.26–0.53) and those reporting non-tolerable gastrointestinal system related side effects reported higher adherence to antidepressants (OR = 1.82, 95% CI = 1.08–3.08).Conclusion: Adherence to antidepressants was associated with side effects, and more precisely with sleep disturbance, gastrointestinal and nervous systems side effects.

Acute Pain Service: A 10-Year Experience.

Pain management after surgery is crucial to decrease perioperative morbidity and mortality. Acute pain services (APS) are multidisciplinary teams that represent a modern strategy to address pain inside hospitals. The APS defines and applies pain treatment protocols specific for each surgery. To evaluate the performance of the APS at our institute, we performed a large retrospective cohort study focusing on complications of epidural analgesia and IV opiates. Data from the 10 years of activity of the APS were collected. Pain was assessed using the VAS at rest (VASr) and during movement (VASm) at each daily visit; the presence of side effects and complications was also assessed. A total of 17,913 adult patients were followed by APS during the study period. Epidural analgesia was used in 7,776 cases (43%), while 9,239 (52%) patients used IV patient-controlled analgesia (PCA). A combination of the 2 was used in 87 patients (0.5%). A total of 456 perineural catheters (2.6%) were placed, while 442 patients(2.5%) used other analgesic techniques. We recorded 163 dural punctures during catheter placement, with no epidural hematoma, epidural abscess, or meningitis, and no permanent modification in sensitive or motor functions. In our large case series, APS was confirmed safe and effective in treating postoperative pain, using both epidural analgesia and IV PCA with morphine.

Microstructural changes of the dentato-rubro-thalamic tract after transcranial MR guided focused ultrasound ablation of the posteroventral VIM in essential tremor.

Essential tremor is the most common movement disorder in adults. In patients who are not responsive to medical treatment, functional neurosurgery and, more recently, transcranial MR-guided focused ultrasound thalamotomy are considered effective therapeutic approaches. However, the structural brain changes following a thalamotomy that mediates the clinical improvement are still unclear. In here diffusion weighted images were acquired in a cohort of 24 essential tremor patients before and 3 months after unilateral transcranial MR-guided focused ultrasound thalamotomy targeting at the posteroventral part of the VIM. Microstructural changes along the DRTT were quantified by means of probabilistic tractography, and later related to the clinical improvement of the patients at 3-months and at 1-year after the intervention. In addition the changes along two neighboring tracts, that is, the corticospinal tract and the medial lemniscus, were assessed, as well as the relation between these changes and the presence of side effects. Thalamic lesions produced local and distant alterations along the trajectory of the DRTT, and each correlated with clinical improvement. Regarding side effects, gait imbalance after thalamotomy was associated with greater impact on the DRTT, whereas the presence of paresthesias was significantly related to a higher overlap between the lesion and the medial lemniscus. This work represents the largest series describing the microstructural changes following transcranial MR-guided focused ultrasound thalamotomy in essential tremor. These results suggest that clinical benefits are specific for the impact on the cerebello-thalamo-cortical pathway, thus reaffirming the potential of tractography to aid thalamotomy targeting.

A Triple-Blind Randomized Trial of Preemptive Use of Gabapentin Before Laparoscopic Hysterectomy for Benign Gynaecologic Conditions.

This study sought to examine the efficacy of preemptive use of gabapentin in laparoscopic hysterectomy for benign gynaecologic conditions. In a triple-blind trial, the study investigators randomly assigned women undergoing laparoscopic hysterectomy to receive 600 mg gabapentin (n = 43) or placebo (n = 45) orally 1 hour before the procedure. Patient-controlled opioid analgesia was provided postoperatively. The primary outcome of the trial was cumulative opioid consumption in the first postoperative 24 hours. The study also assessed pain at rest and on movement, the presence of side effects, and patient satisfaction at 2, 8, and 24 hours after surgery. Between March 10, 2016 and May 1, 2018, 215 women were assessed for eligibility, 110 were randomized, and 88 completed the study. Enrolment was started after trial registration. The investigators found no difference in 24-hour cumulative morphine equivalent opioid consumption between the gabapentin group (26.9±14.7 mg) and the placebo group (27.1±15.1 mg). This provided a mean difference of 0.2 mg (95% CI -6.1 to 6.5, P=0.943). Pain scores at 2, 8, and 24 hours were also not found to differ between groups. Gabapentin was associated with increased dizziness, but it significantly reduced the use of antiemetic at any time in the first 24 postoperative hours. Patient satisfaction in the two groups was good and not found to differ. Preemptive administration of gabapentin before laparoscopic hysterectomy does not decrease postoperative pain scores and narcotic consumption.

Treatment with alemtuzumab or rituximab after fingolimod withdrawal in relapsing-remitting multiple sclerosis is effective and safe.

It has been described that treating relapsing-remitting multiple sclerosis (RRMS) patients with alemtuzumab following fingolimod could be less effective due to the different dynamics of lymphocyte repopulation. Effectiveness and safety of alemtuzumab compared to rituximab after fingolimod withdrawal were analyzed. A follow-up of a cohort of RRMS patients treated with alemtuzumab or rituximab after fingolimod withdrawal was accomplished. Effectiveness, measured by the percentage of patients with no evidence of disease activity (NEDA), and the presence of side effects (SE) were registered. Fifty-five patients, 28 with alemtuzumab and 27 with rituximab, were analyzed. No differences in the washout period or in the baseline lymphocytes counts were observed. After a mean follow-up period of 28.8months, the annualized relapsing rate was significantly reduced in the alemtuzumab group from 1.29 to 0.004 (p < 0.001) and in the rituximab group from 1.24 to 0.02 (p < 0.001), without differences. A significant reduction of the median EDSS from 2.8 to 2.0 in the alemtuzumab group and from 3.5 to 2.5 (p < 0.01) in the rituximab group was observed, without differences. Eighty-two per cent (n = 28) of patients in alemtuzumab group and 69.2% (n = 26) in rituximab group achieved NEDA criteria, without differences (p = 0.3). Symptoms related to the infusion were the most frequent SE in both groups. No serious SE were registered. Treating RRMS patients with alemtuzumab or rituximab after fingolimod withdrawal is effective and safe, without significant differences between both groups in our series.

48 - META-ANALYSIS OF CYP2C19 ASSOCIATION WITH EFFICACY AND SIDE EFFECTS OF CITALOPRAM AND ESCITALOPRAM USING DATA FROM GENOME-WIDE ASSOCIATION STUDIES

Background Major Depressive Disorder (MDD) is a leading cause of disability-adjusted life years worldwide. Genetic polymorphisms may have the potential to guide antidepressant treatment to increase current remission rates. Cytochrome P450 (CYP450) enzymes are responsible for antidepressant metabolism, with CYP2C19 playing a major role in citalopram/escitalopram metabolism. This study is the first meta-analysis to investigate how CYP2C19 polymorphisms predict citalopram/escitalopram efficacy and side effects. Methods CYP2C19 phenotypes comprise poor metabolizers (PM), intermediate and intermediate+ metabolizers (IM; IM+), extensive and extensive+ metabolizers (EM [wild type]; EM+) and ultra-rapid metabolizers (UM) defined by the two most common CYP2C19 functional polymorphisms (rs4244285 and rs12248560). These polymorphisms were directly genotyped or imputed from genome-wide data in four MDD pharmacogenetic samples treated with citalopram or escitalopram (GENDEP, STAR*D, GenPod and PGRN-AMPS). Treatment efficacy was (1) percentage symptom improvement (corrected for covariates and standardized) and (2) remission at endpoint. Side effect data were available only in GENDEP and STAR*D, where side effect from shared categories were analysed (gastro-intestinal, cardiovascular, CNS, sleep and sexual side effects). Presence of side effects were considered at weeks 2, 6 and 9. A fixed-effects meta-analysis was performed, all phenotypic groups were compared among each other using EM (wild type) as the reference group. Standardized mean difference (SMD) or odds ratio (OR) with 95% confidence intervals (CI) were calculated. Results Meta-analyses included 2558 patients for efficacy endpoints and 1644 patients for side effects. Imputed genotypes showed good quality. Compared to EMs, PMs had higher symptom improvement scores (SMD=0.43, CI=0.19–0.66, I2=11.5%) and higher remission rates (OR=1.55, CI=1.23–1.96, I2=0%). At week 2, PMs showed higher risk of gastro-intestinal side effects (OR=1.25, CI=1.06–1.48; week 6 values similar), of CNS side effects (OR=1.29, CI=1.06–1.58) and of sexual side effects (OR=1.56, CI=1.19–2.05; week 6 values similar) with low heterogeneity (I2 range 0% -37%). No difference was seen at week 9 for any side effect; no difference in total side effects burden was observed at any time point. Discussion This meta-analysis supports an association between CYP2C19 metabolizing level and citalopram/escitalopram efficacy and side effects. CYP2C19 polymorphisms may provide helpful information for guiding treatment in PMs.

Determinants of Adherence Levels to Oral Pre-exposure Prophylaxis among Seronegative Partners in HIV Discordant Heterosexual Relationships

Adherence to pre-exposure prophylaxis (PrEP) medication is key for its efficacy in prevention of Human Immunodeficiency Virus (HIV) infection acquisition by uninfected partner in HIV discordant couples during high risk periods of HIV exposure. This study aimed at establishing determinants of adherence levels to oral PrEP drugs among seronegative partners in HIV discordant heterosexual relationships attending and registered at Mbagathi Hospital Comprehensive Care Center (CCC). The study adopted a cross-sectional design that applied two data collection methods: semi structured questionnaires guided interview and a checklist that assessed respondents’ medical records. Both qualitative and quantitative data was collected. Convenience sampling method was used to get a sample size of 51 participants in serodiscordant heterosexual relationships taking oral PrEP. Data was analyzed using Statistical Package for the Social Sciences (SPSS) IBM statistics version 24 software. Both descriptive and inferential analysis were done. Level of significance was set at P value of ≤ 0.05. A higher proportion of the respondents were females (52.9%) and male (47.1%). Most were self-employed (56.9%) with primary level of education (39.2%) and between 30-39 years age group (38%). Adherence levels assessed included; adherence to intake of oral PrEP pills (89.4%), adherence to time of taking PrEP (96%) and adherence to scheduled clinic appointments (80%). Male respondents were 1.01 times more likely to adhere to intake of PrEP pills than females. Determinants that positively influenced adherence to PrEP intake included: increase in age and higher education (p=0.01); longer period of being in HIV discordant relationship (p=0.04); use of condom after PrEP break (p=0.04); partners’ adherence support and having a plan of remembering to take PrEP e.g. an alarm (p=0.04); and increase in frequency of doing a HIV test (p=0.04). Determinants that negatively influenced adherence to PrEP intake included: presence of side effects (p=0.003); engaging in extra marital sex (p=0.04) and alcohol use (p=0.05). The positive determinants of good adherence should be upheld and negative determinants should be addressed. In management of these clients there is need to look out for determinants that promote adherence that include maturity in age, level of education, length of being in discordant status and partners support. Programs should be initiated to create awareness on the effect of bad social habits like alcoholism and extra marital affairs. Laboratory services access should be strengthened in monitoring patients’ adherence and side effects to treatment.

Efficiency of infiltration anesthesia with levobupivacaine and ropivacaine after the knee arthroplasty

Purpose: to study the efficacy and safety of levobupivacaine as the main component of infiltration anesthesia after knee arthroplasty. Patients and methods. Open randomized study included 284 patients (20 - 81 years) after total knee arthroplasty. Patients were divided into 2 groups, 142 patients in each group, depending on the anesthetic used (levobupivacaine or ropivacaine). The severity of pain syndrome within the first 48 hours after the operation by VAS, the need for the use of narcotic analgesics, presence of side effects was evaluated. Results. The mean time of acute pain occurrence was 255±83 min in ropivacaine group and 238±87 min in levobupiavacaine group (p=108). In 4 hours after surgical intervention 30 and 43% of patients from ropivacaine and levobupiavacainegroups required narcotic analgetics, respectively. Neither serious side effects nor complications directly related to infiltration anesthesia were recorded. Conclusion. Infiltration anesthesia with both levobupivacaine and ropivacaine is simple, safe and effective method for pain arrest after surgical interventuions of the knee joint.

Examining Breaks and Resistance in Medication Adherence Among Adolescents With ADHD as Associated With School Outcomes

Objective: Pharmacological interventions combined with behavioral treatment have been associated with better outcomes for children with ADHD. Yet, as children age into adolescence and gain autonomy, they may choose not to adhere to taking a prescribed medication. The purpose of the current study was to examine school outcomes among adolescents with ADHD who take medication breaks versus resisting medication with respect to grades and school behaviors. Method: We statistically controlled for a variety of variables such as the child’s age, sex, the presence of side effects, and parent’s relationship with child. Approximately half of the sample of adolescents with ADHD exhibited some form of medication nonadherence. Results: The results of the current study suggest that more positive school outcomes in terms of behaviors and grades are associated with adolescents taking breaks from their ADHD medication rather than resisting their medication. Conclusion: This result would indicate that not all forms of medication nonadherence have the same association with school outcomes in terms of grades and behaviors.

Cannabidiol for treatment of refractory childhood epilepsies: Experience from a single tertiary epilepsy center in Slovenia

PurposeRefractory epilepsies in children present a major burden for patients and their families. Cannabidiol (CBD) has been suggested as a potential treatment for refractory epilepsies. The aim of this study was to evaluate the effectiveness of add-on therapy with CBD for the treatment of refractory childhood epilepsies. MethodPatients with childhood-onset refractory epilepsy, treated at the tertiary epilepsy center of the University Children's Hospital Ljubljana, Slovenia, were included in the study. Add-on therapy with CBD was initiated once the child's epilepsy was categorized as pharmacoresistant to other antiepileptic drugs/therapies. The dosage of CBD was gradually increased to at least 8mg/kg/day. The effect of CBD treatment was evaluated by the reduction in seizure burden and presence of side effects (positive and negative). Serial electroencephalography was performed in some children. ResultsSixty-six patients were included in the analysis. Thirty-two (48.5%) patients had a more than 50% improvement regarding seizure burden, 14 of whom (21.2%) became seizure-free. None of the patients reported worsening of seizure frequency, but CBD had no effect in 15 (22.7%) patients. Some patients reported less vigorous seizures, shorter duration of seizures, shorter time to recovery, and other positive side effects of CBD treatment. Adverse effects were reported in 5/66 children. ConclusionsIn our cohort of patients, CBD was found to have potential benefits as add-on therapy for refractory childhood epilepsies, mainly by reducing seizure burden.